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Jefferson Memorial Hospital is a non-profit community hospital, located within an hour of St. Louis. It is the sole community provider of healthcare services for Jefferson County and other surrounding communities. With the intent of improving patient access, ed throughput and patient satisfaction, the hospital board backed by the community, invested millions of dollars into redesigning its Emergency Room. In June of 2006, the new emergency room opened. The ER had been designed without a waiting area, - a feature that leadership assumed would lower patient length of stay and eliminate wait times. It boasted 24 private, patient rooms built around a central clinical nursing core. Patient transportation, visitation, and other activities occurred via a perimeter hallway.

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Jefferson Memorial Hospital is a non-profit community hospital, located within an hour of St. Louis. It is the sole community provider of healthcare services for Jefferson County and other surrounding communities. With the intent of improving patient access, ed throughput and patient satisfaction, the hospital board backed by the community, invested millions of dollars into redesigning its Emergency Room. In June of 2006, the new emergency room opened. The ER had been designed without a waiting area, a feature that leadership assumed would lower patient length of stay and eliminate wait times. It boasted 24 private, patient rooms built around a central clinical nursing core. Patient transportation, visitation, and other activities occurred via a perimeter hallway.

By December of 2006, hospital leadership learned that patient throughput times had not improved - ed throughput times had actually increased to 4.61 hours, productivity was at 4.5 hours per patient, and patient satisfaction scores were low at the 2nd percentile. Staff morale was declining. Compounding the situation, the hospital had been advertising "no waiting" for the Emergency Room. In January of 2007, hospital administration brought Jerome Ladous on board as Vice President of Operations to "fix" the Emergency Department.

By May of 2007, Ladous decided to enlist outside help to facilitate change of this size. Compirion Healthcare Solutions, a hospital consulting firm out of Milwaukee was engaged for 6 months to help the hospital staff develop tools and processes in order to effect permanent change. Goals included: improve patient throughput time from over 4 hours down to 3 hours, improve productivity, raise Press Ganey patient satisfaction scores to the 75th percentile and improve core measures scores. The Compirion team built tools to aid in the daily, real-time management of patients and resources. At the beginning of the improvement, LOS was at 4 hours, 12 minutes. At the end of the 6-month process, LOS was at 3 hours and billable patient volume had risen 6%. Productivity went from 3.5 worked hours per patient to 2.9 for a 17% improvement.

At the same time, specific goals were set for treatment of cardio and pneumonia patients: aspirin on arrival for 100% of patients with chest pain, door to PCI within 90 minutes (according to Medicare reimbursement guidelines), and door to EKG within 10 minutes. For pneumonia patients, 100% were to receive a blood culture prior to antibiotic, and an antibiotic within 4 hours of diagnosis. At the end of the engagement, aspirin on arrival, primary PCI within 90 minutes, blood culture prior to antibiotic, and antibiotic within 4 hours of diagnoses were all at the desired 100%.

Prior to the improvement, Jefferson Memorial Hospital did not have a patient satisfaction procedure in place. The team's first step was identifying baseline percentile Press-Ganey rankings, which turned out to be lower than the 20th percentile, and setting goals for increasing scores. At the end of 6-months, Press-Ganey scores were in the 74th percentile.

Unexplained waits in the lobby averaging 23 minutes were looked at next. Initial door-to-treatment time was 59 minutes, and door-to-EKG time was at 35 minutes. Decreasing door-to-treatment time became a primary objective. A Quick Registration process was established. Nine additional standardized triage protocols were instituted based on ESI guidelines. A water cooler and a clock were placed in the lobby for patients, their families and friends. Door to treatment time decreased to 37.5 minutes and door to EKG dropped to 15 minutes.

According to V. P. Operations, Ladous, "What I liked about Compirion was that they used the resources of the hospital, specifically the front line managers, to come up with customized answers to fit Jefferson's needs. Once-a-week we held and still hold Core Team meetings of accountability with the hospital CEO."

E.D. Director, Shelley Layton added, "From my perspective, the accountability was the biggest piece Compirion brought to the table and was worth every penny!"

As part of their Sustainable Results Program, the Compirion team returns twice during the year, at no charge to the hospital, to review and make any adjustments.